Communication Interventions at Discharge Reduce Hospital Readmission

Communication interventions at hospital discharge are significantly associated with fewer readmissions, higher treatment adherence, and higher patient satisfaction.

The findings of the new study suggested healthcare systems implement such communication strategies at discharge to facilitate the transition of care.

Although healthcare practitioners explain critical information to patients at the time of discharge, patient may not understand or remember the information provided, which may result in confusion, misinterpretation, and mismanagement of treatment regimen. Christoph Becker, M.D., and a team of investigators conducted a systematic review and meta-analysis on the association of communication interventions at discharge with readmission rates and other patient-relevant outcomes. Randomized controlled trials were included if the effect of any communication intervention assessed readmission, medical adherence, mortality, satisfaction, medical knowledge, or reattendance to the emergency department. Eligible studies if the intervention was performed shortly before or at hospital discharge, if they had a randomized clinical design, and included medical patients.

The investigative team searched PubMed, Embase, CINAHL, and PsycInfo. Two investigators screened titles and abstracts. They independently extracted data of the studies, then assessed the included randomized controlled trials for methodological quality using the Cochrane Risk of Bias Tool.

The primary endpoint was readmission to the hospital. Additional endpoints included adherence to treatment regimen, satisfaction, mortality, and knowledge of medication or diagnoses assessed 30 days after hospital discharge.

Overall, 60 studies were eligible for inclusion and 19 trials were included in quantitative analysis. Of the 60 studies, 32% reported data about readmission within 30 days after discharge. Among them, 58% had low risk of bias, 32% had high risk, and 11% had unclear risk. The results demonstrated a significant association between communication interventions and fewer readmissions to the hospital (RR, .69; 95% CI, .56-.84).

A subgroup analysis was performed to stratify the type of intervention, age, primary disease, use of handouts, study quality, setting of the study, sex, and location of the study. The team reported a significant difference regarding the main disease of patients with trials including those with respiratory conditions (RR, .32; 95% CI, .18-.57) and patients with other illnesses (RR, .78; 95% CI, .64-.96). Trials with cardiac conditions demonstrated no significant difference (RR, .62; 95% CI, .38-1.02). Further, trials with <50% of patients being women, compared to those with >50% women patients, had better outcomes in hospital admission (RR, .55; 95% CI, .39-.77 vs .82; 95% CI, .64-1.06).

Becker and the team reported that, along with lower readmission rates, there was higher adherence to treatment regimen and higher patient satisfaction for those who had a communication intervention.

The results of the review suggested communication interventions at discharge could help to increase patient knowledge regarding disease, its therapy, and further therapeutic regimen.

The study, “Interventions to Improve Communication at Hospital Discharge and Rates of Readmission,” was published online in JAMA Network Open.